PTSD and traumatic brain injury: folklore and fact? Brain Inj
Community Head Injury Service, The Camborne Centre, Bedgrove, Aylesbury, Bucks, UK. Brain Injury
(Impact Factor: 1.81).
02/2008; 22(1):1-5. DOI: 10.1080/02699050701829696
A number of controversies and debates have arisen over the years surrounding the dual diagnosis of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Many of these have centred around the around the degree of protection provided by TBI against developing the disorder. The following is brief review of the literature in this area to help resolve some of these issues and to address a number of specific challenges which arise when working with this patient group.
Available from: Jin Mo Cho
- "Despite its clinical importance, PTSD in mild TBI patients may not be taken seriously because it could be associated with non-medical factors such as receiving insurance coverage from malingering. So, its prevalence has not been sufficiently investigated and easily ignored14,15,21,23,26). In this report, the authors investigated the prevalence of PTSD after mild TBI, and the clinical efficacy of the PTSD checklist (PCL) for screening the PTSD. "
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Post-traumatic stress disorder (PTSD) is a group of diseases that are observed in patients who had experienced a serious trauma or accident. However, some experienced it even after only a mild traumatic brain injury (TBI), and they are easily ignored due to the relatively favorable course of mild TBI. Herein, the authors investigated the incidence of PTSD in mild TBI using brief neuropsychological screening test (PTSD checklist, PCL).
This study was conducted on patients with mild TBI (Glasgow coma scale ≥13) who were admitted from January 2012 to December 2012. As for PCL, it was done on patients who showed no difficulties in communication upon admission and agreed to participate in this study. By using sum of PCL, the patients were divided into high-risk group and low-risk group. PTSD was diagnosed as the three major symptoms of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders, fourth-edifion.
A total of 314 TBI patients were admitted and 71 of them met the criteria and were included in this study. The mean age was 52.9 years-old (range: 15-94). The mean PCL score was 28.8 (range: 17-68), and 10 patients were classified as high-risk group. During follow-up, 2 patients (2.7%) of high risk group, were confirmed as PTSD and there was no patient who was suspected of PTSD in the low-risk group (p=0.017).
PTSD is observed 2.8% in mild TBI. Although PTSD after mild TBI is rare, PCL could be considered as a useful tool for screening of PTSD after mild TBI.
Available from: Brendan E Depue
- "Neuroimaging studies examining comorbid PTSD/TBI are almost nonexistent, perhaps, because of an old but common notion that an amnesic TBI event was “protective” towards developing PTSD . This idea has been largely reversed in the last 20 years by studies investigating the prevalence of cooccurring PTSD/TBI, which indicate increased rates of PTSD among individuals with a TBI when compared to individuals who have never had a brain injury [17, 18]. "
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ABSTRACT: A significant portion of previously deployed combat Veterans from Operation Enduring Freedom and Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) are affected by comorbid posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). Despite this fact, neuroimaging studies investigating the neural correlates of cognitive dysfunction within this population are almost nonexistent, with the exception of research examining the neural correlates of diagnostic PTSD or TBI. The current study used both voxel-based and surface-based morphometry to determine whether comorbid PTSD/mTBI is characterized by altered brain structure in the same regions as observed in singular diagnostic PTSD or TBI. Furthermore, we assessed whether alterations in brain structures in these regions were associated with behavioral measures related to inhibitory control, as assessed by the Go/No-go task, self-reports of impulsivity, and/or PTSD or mTBI symptoms. Results indicate volumetric reductions in the bilateral anterior amygdala in our comorbid PTSD/mTBI sample as compared to a control sample of OEF/OIF Veterans with no history of mTBI and/or PTSD. Moreover, increased volume reduction in the amygdala predicted poorer inhibitory control as measured by performance on the Go/No-go task, increased self-reported impulsivity, and greater symptoms associated with PTSD. These findings suggest that alterations in brain anatomy in OEF/OIF/OND Veterans with comorbid PTSD/mTBI are associated with both cognitive deficits and trauma symptoms related to PTSD.
Available from: Kristen H Walter
- "It has been proposed that persistent postconcussive symptoms may also be iatrogenic phenomena in some patients (i.e., that diagnosis threat, diagnostic misinformation, or treatment context might contribute to symptom maintenance; Howe, 2009). The interaction between PTSD and history of mTBI has been described as " mutually exacerbating " (King, 2008, p. 3). Extending the notion of mutual symptom exacerbation in PTSD and mTBI, Brenner, Vanderploeg, and Terrio (2009) proposed a model of cumulative disadvantage for understanding the complex clinical presentation and increased risk of poor outcomes when the conditions co-occur. "
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This retrospective study examined treatment adherence in Cognitive Processing Therapy (CPT) for combat-related posttraumatic stress disorder (PTSD) in Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) with and without history of mild traumatic brain injury (mTBI).
Medical record review of consecutive referrals to an outpatient PTSD clinic identified veterans diagnosed with combat-related PTSD who began treatment with CPT. The sample (N = 136) was grouped according to positive (n = 44) and negative (n = 92) mTBI history. Groups were compared in terms of presenting symptoms and treatment adherence.
The groups were not different on a pretreatment measure of depression, but self-reported and clinician-rated PTSD symptoms were higher in veterans with history of mTBI. The treatment completion rate was greater than 61% in both groups. The number of sessions attended averaged 9.6 for the PTSD group and 7.9 for the mTBI/PTSD group (p = .05).
Given the lack of marked group differences in treatment adherence, these initial findings suggest that standard CPT for PTSD may be a tolerable treatment for OEF/OIF veterans with a history of PTSD and mTBI as well as veterans with PTSD alone.
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